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5v SHIP# <br /> Form Approved.()MB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pitch}typewriter.) a.Manifest Tracking Number ,I <br /> 2.Page 1 of 3.Einer ency R s nse Phone K <br /> UNIFORM HAZARDOUS 1.GeneratoriDNumber CAD982497828 B �°8-1760 C i <br /> WASTE MANIFEST J <br /> 5.Gene a ors Name and Mailing Address <br /> 9713 <br /> Generator's Site Address(if different than mailing address) <br /> Gala-ails 10 (Trac - Mail-it) Cal•trarts ICI ;TritcrY 1ai11;; <br /> }60 3 'S Et St. <br /> 2GUS Krohn Fid <br /> STOCKTON CA YS206 'TRACY <br /> Generalors Phone: 209-83S--677Y <br /> U.S-EPA ID Number <br /> SYSTEMS, INC- <br /> US-EPA ID Number <br /> 7.Transporter Z Company Name <br /> 9 Facility SAFETY--9LFEN SYSTEMS .EPA ID Number <br /> 8.Designated Facili Name and Site Address SYSTEMS- INCI t�If;. <br /> 6004 88TH STREET <br /> SACRAIIENTO CA 9SB28 CA0000004S17 <br /> 916--306-4913 <br /> Facjhty's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 19.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)} No. Type Quantity Wt.Nol. <br /> 1 NON-RCRR HAZARDOUS WASTE, LIQUID UN <br /> 1-7 <br /> i A(Ii1EOUS PARTS WASHER SUl_Li i If6F�) <br /> z 2- <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14-Special Harrdlinginstructions arid Additional Informatibn' TSD: SC;At*24AIl CA37086 201 ' CSS: 24 <br /> 7di ( TQC :; <br /> � � ,. rj, , <br /> 24 ISR EMERGENCY til-800-468-1760 (SK / TF'I) <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED 5€ A,+:ARR-IERSt AeA91;E-ASARY <br /> 15. GENERATOR'SrOFFEROR'S CERTIFICATION: I hereby declare that the eonterls of this consignment are fully and'accuratety described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If expert shlpmert and t am the Primary <br /> Exporter,i certify that the contents of this consignment conform to the terms o(the attached EPA Acknowledgmentof Consent <br /> cerlify that the waste minimization statement idem'ed in 40 CFR 262.27(a}lit I am a large quantity genua or(b) .afn a small qua fitrgen�rat r)is true. f <br /> eralor Cfferoes Prinleoyped N /� Si Lure Month Day Yea <br /> j i InlemationalShipments <br /> ❑Import to U.S. ❑Export from US. Po of entrylexii: 61 <br /> Transporter signalure(for exports only}; Oat eavtng U.S' <br /> U 17.Transporter Acknowledgment of Receipt of Materials <br /> Ypar <br /> Tran PrnledRypedNa Signature More 4a� <br /> Transporter 2 Pped Name Signature onth Day Year <br /> rnre <br /> CC ' <br /> t— Ik <br /> 18.Di,crepa Icy <br /> LIZ <br /> 18a-Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ^❑Partici Re'ection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Allemate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> W lSc,5gnature olAftemate Facility(or Generator) Month Day Year <br /> 2 ' <br /> 19.Hazardous Wasle Report Management Method Codes(.e„codes for hazardous waste treatment,disposal,and recycling systems) <br /> n 1. 2 3. 4. <br /> H14i <br /> 20.Designated Facility Owner or Operator;CertiFn,ation of receipt of hazardous malariats covered by the manifest except as noted in Ilem 18a <br /> PnnledlTyped N me _ Signature Month Day Year <br /> EPA Form 670 22{Rev.3 Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> 14911/1 E602j t <br />